By Sarah Bradley
Editor’s Note: Here at The Good Coat, we want to provide an unbiased, inclusive blog that shares both sides of an issue. While we embrace and believe in all that is good about the white coat, others have valid concerns against them; that is the topic we will be exploring in this post. We appreciate the concerns about the white coat, and have in part used them to modernize and reimagine the lab coat. The result is a Good Coat – a modern, functional, safety-feature-laden, high-quality, and stylish symbol of our professions. For more about how we’ve done that, click here.
So far in our historical review of the white coat, we’ve discussed how the white coat originated and what its different lengths mean. And while many providers see white coats as an integral part of their attire – something that signifies the education, professionalism, and expertise with which they step into their caregiving roles each day – there are other providers who’ve come to reconsider the white coat. For these anti-coat providers, the white coat evokes a range of responses: from it not fitting into the way they think medicine should be practiced, to rejecting the coat on a deeper level, uncomfortable with what it symbolizes.
Though the anti-coat providers aren’t a majority of practitioners, they make their voices heard. To understand why a handful of today’s providers are abandoning their white coats, especially before seeing and examining a patient, it helps to divide the anti-coat position into three main arguments:
- Infection concerns;
- White coat syndrome; and
- Resistance to medical hierarchy.
White Lab Coats & Infectious Concerns
Let’s start with infection concerns. Since many providers spend their days around sick people, it stands to reason that they come into contact with germs and other potential pathogens. And because providers are only likely to toss their white coats into the wash every 12 days or so, it’s possible those white lab coats are functioning as petri dishes of viruses and bacteria, running the risk of spreading infections from one patient to the next. Several years ago, concern over this cross-contamination grew so high in the United Kingdom that the National Health Service began banning wrist-length white coats, encouraging its physicians to go “bare below the elbows” to limit the spread of pathogens.
(That’s part of the reason why our Good Coats have vented sleeves, which make rolling up cuffs to the elbows, prior to seeing a patient, an easy task. Good Coats are also made with an antimicrobial fabric to minimize the infection-transmission risk.)
Here in the U.S., some providers hold similar concerns. According to the Association of American Medical Colleges, a 2017 study performed at University Hospitals Cleveland Medical Center showed that long-sleeved lab coats were more likely to wind up contaminated with pathogens than short-sleeved ones (and more likely to transfer those pathogens to dummy patients). However, it’s worth noting that in spite of a small body of research linking white coats to higher levels of pathogens, there aren’t any studies showing an actual increased risk of infection to patients because of providers wearing white coats.
White Lab Coats & “White Coat Hypertension”
Now, what about white coat syndrome (a.k.a. “white coat hypertension” or the “white coat effect”)? Maybe you’ve experienced this yourself in the provider’s office: you’re feeling cool, calm, and collected in the waiting room, but as soon as your provider enters your exam room, your blood pressure climbs. You swear you don’t really have high blood pressure – the provider’s office just makes you nervous! – but it’s hard to argue with the numbers.
Interestingly, though, white coat syndrome is generally accepted as a legitimate condition. The American College of Cardiology estimates that anywhere between 20 and 50 percent of people experience it at their provider’s office, making it a challenge at first to separate out those patients who truly have hypertension from those who simply have anxiety about going to see their health care provider. It’s enough to make some providers question whether they really need (or want) to put on their professional white lab coats before seeing patients.
On the other hand, for every patient whose heart palpitates upon seeing a provider in a white coat, there’s another patient who feels instantly comforted. In part one of this series, we mentioned a massive study of more than 4,000 hospital patients published in June of 2018 revealing that what providers wear matters a great deal to the people they treat every day. Out of four options for attire offered on the survey, wearing a white coat with formal attire (dress shirts and suit pants or jackets) scored highest. So providers who believe the white coat makes them appear more trustworthy and capable in the eyes of their patients are totally right.
White Lab Coats & Medical Hierarchy
Lastly, there’s the issue of medical hierarchy to unpack. If you read part two of this series, you know that medical students (and at some hospitals, medical residents and interns) are required to wear shorter, hip-length coats than more senior physicians. This sets students and junior doctors-in-training apart from senior doctors, which has both advantages and disadvantages. Some doctors with concerns about this ranking system feel that a junior doctor would be less inclined to speak up if they spot a senior doctor about to make an error, while other doctors feel this segregation inhibits the kind of “team player” mentality needed within hospital units.
Because of the hierarchy inherent in the symbolism of the white lab coat, many providers opt out of wearing them entirely. For example, in her 2016 guest post on the KevinMD.com blog, Kristin Prentiss Ott, M.D., discussed how the distinction between coat lengths informs her decision not to wear a coat at all (she chooses to wear scrubs instead).
“Wearing ‘special’ garments to stand out is a symptom of a culture that elevates some and diminishes others,” she wrote. “It’s bad for morale. Imagine working for a boss who walked around wearing a hat emblazoned with ‘CEO.’ Not cool.”
The Positive Power of Professional White Lab Coats:
Would you want to see your airplane pilot in the cockpit wearing shorts and a tank top?
Still, plenty of physicians believe strongly in the positive power of white coats. Just two years later on that same blog, Robert Baker, M.D., argued in favor of the white coat, shooting down claims that the coats are unsanitary, old-fashioned, or elitist. Instead, he said, the white coat is an integral part of the provider’s wardrobe and visit itself, as much expected by patients as a provider’s empathy and understanding.
Dr. Baker describes going to see a health care provider as a kind of ritual, where a patient performs a series of actions expecting to be “healed” in some way. He goes on to explain the role of the white coat within this ritual: “[It] is part of our costume and gives us an aura of professionalism and authority. And if you don’t think that’s important, consider how you’d feel about getting on an airplane if the pilot in the cockpit were wearing shorts and a tank top.”